Clinical Outcomes following Supraorbital Foraminotomy for Treatment of Frontal Migraine Headache

Abstract

Purpose While 92% of patients who undergo surgical decompression of the supraorbital nerve for treatment of frontal migraine headaches through resection of the glabellar muscle group (GMG) achieve at least 50% improvement, only two thirds demonstrate complete resolution of symptomatology. The purpose of this study was to investigate the role of additional decompression methods by comparing surgery outcomes between patients who underwent supraorbital foraminotomy in addition to glabellar myectomy. Materials and Methods Outcome measures including; migraine headache frequency, severity, duration, Migraine Headache Index (MHI), and forehead pain were retrospectively reviewed and statistically analyzed for 43 age-matched control patients who underwent glabellar myectomy for release of the supraorbital nerve and 43 patients who underwent glabellar myectomy with supraorbital foraminotomy from 2002–2010. Results The myectomy group (M) statistically matched the myectomy with foraminotomy group (MF) for age, number of surgical sites, and pre-operative headache characteristics (p > 0.05). Post-operative migraine frequency per month was 7.8 per month (M) versus 4.1 (MF), severity was 5.6 (M) versus 4.4 (MF), migraine headache index (MHI) was 26.5 (M) versus 11.1 (MF), and persistent forehead pain was 48.8% (M) versus 25.6% (MF). These differences were all statistically significant (p < 0.05). Duration of headache was unchanged (p = 0.17). Conclusion The supraorbital foramen is a potential site of supraorbital nerve compression that can trigger frontal MH. If present, we strongly recommend foraminotomy to ensure complete release of the supraorbital nerve to optimize outcomes. Our results also support consideration of release of any fibrous bands across the supraorbital notch.

Emergence of Secondary Trigger Sites after Primary Migraine Surgery

“…It is also possible that some migraine sufferers have diffuse dysfunction in pain pathways (e.g., hyperexcitable neurons, dysfunction in antinociceptive periaqueductal gray matter, and cortical spreading depression). 6 This implies that migraine suffers are more susceptible to nerve irritation and trigger site activation. Clinically, several mechanisms may account for new postsurgical migraines.…”

A Review of Current Evidence in the Surgical Treatment of Migraine Headaches

“…In 2012, Chepla et al 28 hypothesized that incomplete decompression of the frontal trigger site may be related to the presence of a supraorbital foramen, as opposed to a supraorbital notch, in a percentage of patients. Indeed, as many as 25% of people possess a supraorbital foramen.…”

Chronic migraine

“…[95][96][97][98] Surgical deactivation of migraine trigger sites has been investigated in observational studies and a small controlled trial. [99][100][101][102] However, results from randomized controlled multicenter trials with long term follow-up have not been published. Therefore, there is currently insufficient evidence to support the use of such surgery for the treatment of migraine and it should be considered only within the context of clinical research trials.…”